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General NPI Number Information
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NPI Number | 1639583222
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Entity Type | Individual
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Provider Name | ALEASHA ELLIOTT APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 111 CHURCH ST STE 10
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-486-6770
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Fax | 866-783-4604
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Provider Business Mailing Address
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Address Line | 3289 MANGO DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-0195
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Country | US
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Telephone | 573-560-8046
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Fax | 636-266-8286
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2014017980
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License Number State | MO
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